I’m a pediatrician, an infectious disease pediatrician at that. We’re supposed to know what to do when a baby has pneumonia—apparently that’s not always true. I’ve treated hundreds of such cases, but this time was different.

When it’s your own infant, none of that experience matters. Jack looked at me with what seemed like panic in his eyes. Coughing, crying, breathing fast, sleeping in fits and spurts. Babies aren’t supposed to breath that fast. He lay beside me in bed. It was the day before Christmas and I just kept telling myself that we’d be better soon—apparently that’s not true either.

We both had influenza, I’m sure of that. If you’ve had it, you’ll know what I mean. I felt like hell, exhausted, muscle aches, every time I coughed it felt like sandpaper scraping over my trachea. But since I’m an infectious disease doc, of course we were vaccinated! Well, apparently that wasn’t true this year. I had every intention of getting that done weeks earlier, but life got in the way.

The middle of the night always makes things worse, or at least things seem worse. So, we became ‘that family,’ calling our neighbors in the middle of the night to care for our two-year-old while we drove to the hospital with Jack. So many times I was that doctor we were about to meet in the emergency room, scratching my head wondering, “Why did they wait the whole day at home and decide to finally come in at 2:00 in the morning?”

Well, now I knew. Sometimes it doesn’t get better. He had pneumonia on the chest x-ray and needed antibiotics.

Every day, of every year, millions of children get pneumonia and struggle to breath; more than a million of them don’t get the treatment they need and die. Every day of every year, something unimaginable to the mothers we are happens to mothers we don’t know—over 90% of them living in poor countries in Africa and Asia—their child dies in front of their eyes from pneumonia. It’s senseless. It’s inhuman.

Vaccines against the biggest pneumonia-causing bacteria, Hib and pneumococcus, along with other simple strategies, can prevent these deaths. So, this year on World Pneumonia Day, look at your kids and remember to get them vaccinated, remember to get yourself vaccinated, and remember that not every mother is so lucky . . . yet.

The GAVI Alliance is helping give those mothers the same opportunity for their kids, faster than ever before for any vaccine. At a time when the world seems to be more complicated than ever, this seems like a pretty sensible thing to do.

As the number of Americans with no health insurance soars and more people use the emergency room as a primary care clinic, it is no wonder many Americans have the jitters about healthcare.

With all the news coverage and grim forecasts, it’s easy to forget that many aspects of modern medicine are dramatically superior to days of yore.

Take Arcagathusfor example: the first doctor in Rome, he was widely admired until word got around that his use of knives and cautery was more likely to bury the patient than heal him. Thereafter, he was known as the “Executioner.”

Nowadays, we can be grateful that physicians have to go to school and learn all sorts of ways not to harm a patient before they’re allowed near one.

Modern medicine may be expensive and over-prescribed, but as a rule it doesn’t contain heroin.

In the late 1800s, Bayer added heroin to their cough suppressant for kids, and boy did it work. But after a few years, people noticed the hospitals were filling up with addicts. They still weren’t coughing, but what a trade-off! By the early 1900s, Bayer pulled the drug.

On the upside, and at about the same time, Bayer brought aspirin to us, and where would we be without it?

Reports from two centuries ago of experimental treatments by the surgeons of the Royal Navy provide additional perspective on today’s healthcare woes: One pneumonia patient had pints of blood removed in an effort to cure him—it was called bloodletting. He still managed to expire, confounding his surgeon. Another Royal Navy favorite was “tepid salt water baths.” Surprisingly, there were never any survivors of this therapy. One poor sod who fell overboard and nearly drowned had tobacco smoke blown on him as a cure. He did survive, but ended up hospitalized for pneumonia.

In ancient Mesopotamia, a sorcerer would be called in to determine which god caused what illness in a patient. Having identified the god, the sorcerer would attempt to send it away with charms and spells. We do not have accurate records as to the success rate of this treatment.

The Egyptians believed mightily in the practice of medicine and left copious notes on papyrus for following generations. Dr. Bob Brier shared some of their cures in his book, Ancient Egyptian Magic. After reading a bit, our mood elevated, our perspective shifted, and we decided to just shut up and soldier on, happy with the modern medicine we have.

In case you’re curious about what was written on some of that papyrus, read on, but do not try this at home:

Cure for Indigestion

Crush a hog’s tooth and put it inside of four sugar cakes. Eat for four days.

Cure for Burns

Create a mixture of milk of a woman who has borne a male child, gum, and ram’s hair. While administering this mixture say:

Thy son Horus is burnt in the desert. Is there any water there? There is no water. I have water in my mouth and a Nile between my thighs. I have come to extinguish the fire.

Cure for Lesions of the Skin

After the scab has fallen off put on it: Scribe’s excrement. Mix in fresh milk and apply as a poultice.

Cure for Cataracts

Mix brain-of-tortoise with honey. Place on the eye and say:

There is a shouting in the southern sky in darkness, There is an uproar in the northern sky, The Hall of Pillars falls into the waters. The crew of the sun god bent their oars so that the heads at his side fall into the water, Who leads hither what he finds? I lead forth what I find. I lead forth your heads. I lift up your necks. I fasten what has been cut from you in its place. I lead you forth to drive away the god of Fevers and all possible deadly arts.

Modern healthcare certainly has its problems, but at least today’s patients are free of spells, tobacco smoke and bloodletting. Is that better than a 4-hour ER visit? You be the judge.

More young children die from pneumonia each year than from any other single cause—including war, famine, or any other disease.

How did this happen? It’s preventable and treatable. How did we get to where we are today while allowing this to continue?

We lose a child to pneumonia every 15 seconds, a total of 2 million children a year. That’s unacceptable.

We know how to fight back against pneumonia, but we just aren’t doing it. Children’s lives can be saved by increasing vaccination, antibiotic treatment, and breastfeeding and by practicing thorough, frequent handwashing and reducing indoor air pollution

November 2nd is the first annual World Pneumonia Day. A global coalition has formed to take on this killer. It is our hope that, if we all pitch in, we’ll swiftly work ourselves out of a job.

Breastfeeding may help protect newborns against influenza, but mom’s good handwashing habits before and after breastfeeding are just as important. If you are on medication for flu, you can still breastfeed. Your provider may suggest that you wear a mask when near your baby. If you have symptoms, you can still breastfeed; the milk is not contagious. But stay away from your baby if you are feverish.

Mothers who are infected with H1N1 when they deliver do not necessarily have to be separated from their newborn. A mother on medication should be able to breastfeed; separating her from her infant would not be advantageous. A mother who is actively sick with symptoms will not be very capable of caring for an infant and will need help, which will also help minimize contact and transmission. All caregivers should be vaccinated, and should also get a Tdap vaccination (tetanus, diphtheria, pertussis).

Do I need to worry about outbreaks in schools?

Because of the H1N1 outbreaks in community settings (camps, e.g.) this summer, experts do expect schools to be breeding grounds for H1N1.

School closure is an option, but is not expected to be necessary. Students (or anyone) with flu symptoms should stay home.

Other Concerns

Getting the pneumococcal vaccine can help reduce your risk of developing pneumonia as a complication of influenza infection.

For mothers infected with H1N1, masks are recommended in certain circumstances. Talk with your provider if you’re concerned. You should not need to wear a mask or gloves at home.

Do NOT attend a “flu party.” You should NOT purposefully infect yourself, or your children, with H1N1.

Recommendations

Fever and respiratory symptoms need to be taken seriously. Call your provider if you have any symptoms or concerns. Ask them for specific instructions; for example, they may want you to put on a mask before entering their office to help prevent infecting pregnant women.

Get vaccinated for both seasonal and H1N1 flu viruses. The seasonal vaccine will not protect you against H1N1.

Wash your hands often.

Maintaining good nutrition and getting plenty of rest will also help prevent illness.

Continue to receive prenatal care from your provider.

Everyone who is sick should stay home.

To get vaccinated, talk with your provider. OB/GYNs are supposed to receive vaccine to have on hand, in addition to clinics, pharmacies, and other typical venues for flu vaccine administration. If you have any concerns, about anything, at any time, talk with your provider – that’s what they’re there for!

Littleton, Colorado — Every year, diarrhea and pneumonia kill more than 3.5 million children under age 5 worldwide. Many of them could have been saved by the simple act of washing hands.

Studies have shown that handwashing with soap can cut deaths from diarrhea by almost 50 percent and deaths from acute respiratory infections by 25 percent — saving more lives than any single vaccine or medical intervention. The challenge is to transform handwashing with soap from an abstract idea into an automatic behavior in homes, schools and communities worldwide.

To promote this life-saving habit, millions of children in 20 countries across five continents will participate in the first Global Handwashing Day on October 15. Supporters of the event will focus on mobilizing school children worldwide to wash their hands with soap to increase the practice of this important behavior.

Global Handwashing Day is supported by the Global Public-Private Partnership for Handwashing with Soap (PPPHW). Established in 2001, partnership members include the U.S. Agency for International Development (USAID), World Bank, Water and Sanitation Program, UNICEF, Unilever, Water Supply and Sanitation Collaborative Council, U.S. Centers for Disease Control and Prevention, Procter & Gamble, Colgate-Palmolive and the Johns Hopkins University School of Public Health.

“Global Handwashing Day is designed to bring international and individual country attention to this critical public health intervention,” John Borrazzo, chief of the Maternal and Child Health Division, USAID Bureau for Global Health, told America.gov.

The event supports the 2008 World Water Week conference’s international focus for this year on sanitation. (See “2008 World Water Week Highlights Water-Related Challenges.”)

“Global Handwashing Day is important because diarrhea still unnecessarily kills 1.6 million children a year, and we know that effective handwashing with soap can prevent almost 50 percent of these diarrhea [illnesses],” Borrazzo said. “Recent research results also show that effective handwashing by birth attendants and mothers may reduce newborn deaths — which globally total 4 million a year — by as much as 40 percent.”

OBSERVANCES PLANNED AROUND THE WORLD

During the week of October 15th, from India to Egypt, Peru to China, Indonesia to Ethiopia, high-profile promotional and educational activities are planned for school children, teachers and parents — joined by government officials and celebrities — to raise awareness that handwashing with soap is a powerful public health intervention.

In Madagascar, President Marc Ravalomanana and the government of Madagascar worked with the USAID Hygiene Improvement Project (HIP), local soap companies, the media and others to plan an all-out national weeklong celebration of Global Handwashing Day. During the week of October 15, all of Madagascar’s 19,300 primary schools will participate in the activities, culminating with 3.5 million children all washing their hands at noon on Global Handwashing Day. A parade of schoolchildren through the capital also is planned for October 15.

In Pakistan, the country’s vision for Global Handwashing Day is to have 1 million school children across the country all wash their hands on October 15. This will be accomplished through many local groups and school programs working with members of the PPPHW, including USAID and multinational consumer products maker Procter & Gamble.

USAID’s Pakistan Safe Drinking Water and Hygiene Promotion Project (PSDW-HPP) plans to celebrate with 65 partner nongovernmental, community and government organizations. Planned activities include interactive theater performances, speeches from community leaders and creative classroom activities to complement the interactive hygiene curriculum currently used by PSDW-HPP in more than 20,000 schools. School activities will end with an oath to always wash hands with soap at critical times and to help others to do so.
Procter & Gamble intends to teach 75,000 Pakistani children via its Safeguard Schools Program on October 15.

INTERNATIONAL HYGIENE EDUCATION PROJECTS

For many years, U.S. public and private organizations have joined with other countries to help develop the vital habit of handwashing with soap.

“USAID has long recognized the importance of incorporating hygiene education and handwashing promotion as part of both maternal and child programs, and water supply and sanitation activities,” Borrazzo said. “We have worked for over a decade with many international partners to encourage handwashing, including promotion through the community, private sector, health facilities and schools.”

For example, USAID has been assisting with hygiene-behavior education through one component of USAID’s participation in the $59 million West Africa Water Initiative (WAWI) that began in 2002. WAWI’s 13 partner organizations — including the Conrad N. Hilton Foundation, World Vision, UNICEF, USAID, WaterAid, Winrock International and World Chlorine Council — work in Ghana, Mali, Niger and Burkina Faso.
Multiple USAID programs partner with international organizations in many countries to carry out relevant hygiene education and sanitation programs, including in Ethiopia, Nepal, Madagascar, Pakistan and Indonesia.

“School programs that teach the benefits of handwashing and effective handwashing techniques have been shown to increase handwashing behavior,” Jay Gooch, associate director of external relations for Procter & Gamble, told America.gov. “Young people are the most effective age group to reach to develop this habit,” he said.

In Pakistan, 7.5 million schoolchildren have participated in Procter & Gamble’s Safeguard Schools Program since 2003. In a country where more than 250,000 Pakistani children die from diarrhea annually, the practice of handwashing could save many lives.

In China, more than 24 million school children have participated in Procter & Gamble’s Safeguard Schools Program since 1999.

More information is available on the Web sites for Global Handwashing Day and the Global Public-Private Partnership for Handwashing with Soap.

Disclaimer

The information on PKIDs' Blog is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for you or your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.